Introduction

Human Enhancement Ethics: TheState of the DebateNick Bostrom and Julian Savulescu

Background

Are we good enough? If not, how may we improve ourselves? Must werestrict ourselves to traditional methods like study and training? Or shouldwe also use science to enhance some of our mental and physical capacitiesmore directly?

Over the last decade, human enhancement has grown into a majortopic of debate in applied ethics. Interest has been stimulated by advancesin the biomedical sciences, advances which to many suggest that it willbecome increasingly feasible to use medicine and technology to reshape,manipulate, and enhance many aspects of human biology even in healthyindividuals. To the extent that such interventions are on the horizon(or already available) there is an obvious practical dimension to thesedebates. This practical dimension is underscored by an outcrop of thinktanks and activist organizations devoted to the biopolitics of enhancement.Already one can detect a biopolitical fault line developing between pro-enhancement and anti-enhancement groupings: transhumanists on oneside, who believe that a wide range of enhancements should be developedand that people should be free to use them to transform themselves inquite radical ways; and bioconservatives on the other, who believe thatwe should not substantially alter human biology or the human condition.¹There are also miscellaneous groups who try to position themselves in

¹ See e.g. Bostrom, N. 2006. ‘A Short History of Transhumanist Thought’, Analysis and Metaphysics,5: 63–95 (http://www.nickbostrom.com/papers/history.pdf ).

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between these poles, as the golden mean. While the terms of this emergingpolitical disagreement are still being negotiated, there might be a windowof opportunity open for academic bioethicists to influence the shape anddirection of this debate before it settles into a fixedly linear ideologicaltug-of-war.²

Beyond this practical relevance, the topic of enhancement also holdstheoretical interest. Many of the ethical issues that arise in the examinationof human enhancement prospects hook into concepts and problems ofmore general philosophical significance—concepts such as human nature,personal identity, moral status, well-being, and problems in normative eth-ics, political philosophy, philosophy of mind, and epistemology. In additionto these philosophical linkages, human enhancement also offers thought-fodder for several other disciplines, including medicine, law, psychology,economics, and sociology.

The degree to which human enhancements constitute a distinctive clusterof phenomena for which it would be appropriate to have a (multidisciplin-ary) academic subfield is debatable, however. One common argumentativestrategy, used predominantly to buttress pro-enhancement positions, is tohighlight the continuities between new controversial enhancement meth-ods and old accepted ways of enhancing human capacities. How is takingmodafinil fundamentally different from imbibing a good cup of tea? Howis either morally different from getting a full night’s sleep? Are not shoes akind of foot enhancement, clothes an enhancement of our skin? A notepad,similarly, can be viewed as a memory enhancement—it being far fromobvious how the fact that a phone number is stored in our pocket insteadof our brain is supposed to matter once we abstract from contingent factorssuch as cost and convenience. In one sense, all technology can be viewedas an enhancement of our native human capacities, enabling us to achievecertain effects that would otherwise require more effort or be altogetherbeyond our power.

Pushing this thought further, one could argue that even mental algorithmssuch as we use to perform basic arithmetic in our heads, and learned skillssuch as literacy, are a kind of enhancement of our mental software.When we learn to calculate and read we are literally reprogramming the

² For one early discussion, see Glover, J. 1984. What Sort of People Should There Be? (Harmondsworth:Penguin).

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micro-structure of our nervous system, with physiological effects just asreal as those resulting from the ingestion of a psychoactive drug, and oftenmore durable and with more profound consequences for our lives. At thelimit of this line of reasoning, all learning could be viewed as physiologicalenhancement, and all physical and organizational capital could be viewedas external enhancements. Stripped of all such ‘‘enhancements’’ it wouldbe impossible for us to survive, and maybe we would not even be fullyhuman in the few short days before we perished.

If the concept of human enhancement is stretched to this extent, itbecomes manifestly unfit for service as an organizing idea for a new anddistinctive field of ethical inquiry. This need not trouble enhancementadvocates who maintain that there is no morally significant differencebetween novel biomedical enhancements and all the other more familiarways of enhancing. Those who object to human enhancement, however,must resist this inflationary interpretation of what enhancement is, drawinga line somewhere to distinguish the problematic new types of enhancementsfrom the unobjectionable use of shoes, clothes, tea, sleep, PDAs, literacy,forklifts, and the bulk of contemporary medicine.

Such a line need not be sharp. Many important and useful philosophicalterms are vague. Nevertheless, two challenges must be met. First, someaccount needs to be given of what counts as an enhancement—an accountthat must be reasonably intelligible and non-arbitrary, capturing somethingthat might plausibly be thought of as a kind. Second, given such anaccount, it needs to be shown that it tracks a morally relevant distinction.Unless these two challenges can be met, it would appear misguidedto organize our ethical thinking in this area around the concept ofenhancement. ‘‘Enhancement’’ might still be useful to flag a patch ofterritory consisting of a variety of loosely related practices, techniques, andprospects. But it would hardly make sense either to pledge allegiance tosuch a flag, or to devote oneself to opposing what it stands for. Instead, ourethical judgments would have to track different and finer distinctions thatwould reflect the concrete circumstances and consequences of particularenhancement practices: Precisely what capacity is being enhanced in whatways? Who has access? Who makes the decisions? Within what cultural andsociopolitical context? At what cost to competing priorities? With whatexternalities? Justifiable ethical verdicts may only be attainable followinga specification of these and other similarly contextual variables. To accept

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this conclusion is to accept a kind of normalization of enhancement. Thatis, at a fundamental normative level, there is nothing special about humanenhancement interventions: they should be evaluated, sans prejudice andbias, on a case-by-case basis using the same messy criteria that we employin other areas of practical ethics.³

The contributors to this volume bring to the table a variety of perspect-ives, from both sides of the debate and from both Eastern and Western,secular and religious traditions. We have organized the chapters into tworoughly distinguishable groups. First, those dealing with the ethics ofenhancement more or less in general, and with associated issues such asthe normative significance of human nature. Second, those focusing onthe ethics of some particular type of enhancement. This is followed by afinal chapter that addresses enhancement medicine as a practical (scientific)challenge.

Enhancement in general

N D asks what it would take to change human nature. Heargues that this is a taller order than might at first appear to be the case.Human nature, says Daniels, is a dispositional selective population concept.It is dispositional in the sense that the same human nature will manifest asvery different phenotypes depending on the environment in which it isplaced. It is a population concept in the sense that to characterize humannature we must aggregate across individual variation. And it is selective in thesense that some traits (e.g., rationality) are often claimed to be more centralto human nature than others (e.g., nasal hair). On this account, we cannotmodify human nature unless we act on a population level. Furthermore, theintervention must affect traits central to that nature. To Daniels, this suggeststhat ‘‘genetic interventions are less likely to be threats than environmentalinterventions that undermine our human capabilities or nature.’’

It has been argued that human germ-line engineering must be opposed ongrounds that it would change human nature. George Annas, in particular,has been promoting the need for a new U.N. ‘‘Convention on thePreservation of the Human Species’’, which would realize itself in an

³ Even ethical theories that are simple in their structure—such as hedonism—become complex andmessy in their application to many real-world predicaments.

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international treaty to ban ‘‘species altering’’ research. Annas claims that‘‘cloning and inheritable genetic alterations can be seen as crimes againsthumanity of a unique sort: they are techniques that can alter the essence ofhumanity itself.’’ The chapter by E J offers a critique of this view.

Juengst notes that species are not ‘‘static collections of organisms that canbe ‘preserved’ against change like a can of fruit; they wax and wane withevery birth and death and their genetic complexions shift across time andspace.’’ Interpreted strictly, a ban on altering the human species would covertoo much since almost everything we do as humans might affect the geneticcomposition of the next generation. (Taken literally, such a ban wouldseem to require the universal adoption of cloning as the sole method ofreproduction.) Yet if the proposed ban on ‘‘species altering’’ is given a morerelaxed reading—as, say, a proscription of interventions that would alterour ‘‘taxonomically defining’’ traits or that would significantly alter humannature—then it would fail to serve its intended purpose. For under thisinterpretation, even most germ-line modifications, genetic enhancements,and reproductive manipulations, like cloning, would not be species altering.

R I presents an Asian bioconservative perspective on humanenhancement. Ida tells us that, ‘‘in Japan,’’

we respect the view of ‘As it stands’ . . . This attitude expresses respect for Natureand for the natural state of the baby. . . Ethical appeals to the human welfare orindividual happiness to justify the use of science of technology may have intuitiveforce in the West, but may seem alien to a non-Western audience.

Ida distinguishes between ‘‘natural improvement’’ such as may come aboutthrough training and study, and ‘‘unnatural improvement’’ such as mayresult from taking anabolic steroids. The latter kind of improvement, hebelieves, may not be permissible because it depends on and fosters aninstrumentalist or dualistic view of human beings. On this view, as Idapoints out, it is not only newfangled enhancement interventions such asmemory enhancing drugs or genetic engineering that are morally suspect.Much of what Westerners now consider to be normal therapeutic medicineis also problematic:

Oriental medicine has as its basic principle the reestablishment of the balance ofbody and soul. All the diseases come from the imbalance of the patient. It is truethat this type of medicine does not practice big operations, like organ transplants,or brain operations. Oriental medicine sees the conditions that might call for

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such interventions as natural, simply a consequence of human mortality, and itaccordingly sees such a patient as entering a stage of returning to nature, i.e. dying.

Ida notes that in East and South East Asia, Buddhism and Confucianismoften have a dominant role in daily life, and the life style and social practicesare still rooted in agricultural traditions.

While the sensibilities that Ida describes may seem somewhat alien toWestern bioethicists—especially the idea that there are any kind of ethicalgrounds for recoiling from ‘‘big operations’’ and organ transplantations—aposition quite close to that of Ida has recently been articulated by M

S, an American political philosopher who has served on the Pres-ident’s Council on Bioethics during the George W. Bush administration.Sandel warns that enhancement and genetic engineering represent a kind of‘‘hyperagency’’—a dark Promethean aspiration to remake nature to serveour purposes and satisfy our desires. We are at risk, Sandel believes, oflosing our ‘‘openness to the unbidden’’:

The problem is not the drift to mechanism but the drive to mastery. And whatthe drive to mastery misses and may even destroy is an appreciation of the giftedcharacter of human powers and achievements . . .To acknowledge the giftednessof life is to recognize that our talents and powers are not wholly our own doing,despite the effort we expend to develop and to exercise them.

When put in this way, however, the objection becomes a concern about acontingent and speculative psychological effect of the practice of enhance-ment. One could imagine an enhancement user who is under no illusionthat her talents and powers are wholly her own doing, understanding clearlythat without the contributions from Nature, God, or Fortune she wouldbe literally nothing.

Perhaps one solution would be for the FDA to require appropriatelabeling of enhancement products. A bottle of memory-boosting pillscould come with the inscription:

MAY CAUSE CONSTIPATION, DRY MOUTH, SKIN RASHES, ANDLOSS OF OPENNESS TO THE UNBIDDEN. IF SYMPTOMS PERSISTAFTER 48 HRS, CONSULT YOUR PHYSICIAN AND/OR YOUR SPIR-ITUAL ADVISOR.

A more philosophically sophisticated response to Sandel’s argument is onoffer in the chapter by F K. She considers whether, as Sandel

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claims, the desire for mastery motivates enhancement and whether sucha desire could be a ground for its impermissibility. Kamm also examinesSandel’s views about parent/child relations, and how enhancement wouldaffect distributive justice and the duty to aid. She also discusses thetherapy/enhancement distinction and criticizes some recent attempts toexplicate this distinction in a way that would allow it to carry normativeweight, including attempts by Sandel and by P. H. Schwartz.

The therapy/enhancement distinction comes in for further scrutiny inthe chapter by J H. He critiques the idea, developed by NormanDaniels and others, of using the notion of normal or ‘‘species typical’’ func-tioning as the dividing line separating morally high-priority interventions(those aimed at preserving or restoring normal functioning) from morallylow-priority interventions (those aimed at enhancing normal functioning).Arguing from a consequentialist position, Harris concludes that

[t]he overwhelming moral imperative for both therapy and enhancement is toprevent harm and confer benefit. Bathed in that moral light it is unimportantwhether the protection or benefit conferred is classified as enhancement orimprovement, protection or therapy.

Harris also briefly touches on some other objections to enhancement,including the ‘‘playing God’’ objection, which he gives short shrift. Thisobjection is treated in more detail in the chapter by T C. Theobjection may, but need not, rely on theological assumptions. Coady dis-tinguishes three traditions in Christian theology regarding the relationshipbetween human beings and the natural order: domination, stewardship, andco-creation. According to the domination model, humans were createdto lord it over nature. According to the stewardship model, the role ofhumans is to act to preserve the natural order. And in the metaphor ofco-creation, God has called human beings into a creative partnership in theongoing creation of the world. The domination model has been criticizedas insensitive to ecological concerns; the stewardship model for accord-ing an unduly passive role to a species endowed with as much initiativeand creativity as ours; and the co-creation for downplaying the distancebetween God and creatures. Coady thinks that all three models have anelement of truth in them, and that ‘‘the dialogue between them exhibitsthe tensions that need to be kept in view by believers in negotiating themystery of humanity’s place in the created order’’.

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In its secular interpretation, the critique of playing God seems primarilya criticism of an attitude (hubris) and only derivatively of a program orproposal. Coady suggests that when people worry about the application ofthe latest scientific and technological discoveries and put this worry in termsof ‘‘playing God’’, they are concerned that these applications may embodyan unjustified confidence in knowledge, power, and virtue beyond whatcan reasonably be allowed to human beings. Overzealous transhumanistsdo not have a monopoly on this vice, as Coady writes:

The temptation to act in ways that ignore or make light of the in-built constraintson human knowledge, power and benevolence is certainly one to which allhumans are prone, including bishops, theologians and priests. Indeed, those whobelieve that they are privy to God’s purposes through revelation, inspiration ortradition or all combined are perhaps especially open to the temptation. We shouldrecall in this connection the sad history of religious wars, crusades, inquisitions,the preaching of erroneous doctrines and the failure to preach important truths. Iam a Catholic, and my own Church has its blemishes in all these regards.

E P, in a similarly conciliatory spirit, suggests that proponents andcritics of enhancement technologies, while often talking past one another,have more in common than they realize. Parens believes that both groupsproceed from a ‘‘moral ideal of authenticity’’, although they differ in howthey understand this ideal, and he believes that these different understandingsof authenticity ‘‘grow out of two different but equally worthy ethicalframeworks, which stand in a fertile tension with each other’’.

It may be apropos to mention a recent psychological study, which foundthat people are much more reluctant to enhance traits believed to befundamental to self-identity (e.g., social comfort) than traits considered lessfundamental (e.g., concentration ability)—consistent with the idea thatbeliefs about authenticity may be an important shaper of attitudes towardsenhancement.⁴ However, the same paper also found that perceptionsabout authenticity could be easily manipulated. Advertisement taglinesthat framed enhancements as enabling (‘‘Become Who You Are’’) rather

⁴ Riis, J., Simmons, J. P. and Goodwin, G. P. Forthcoming. ‘Preferences for EnhancementPharmaceuticals: The Reluctance to Enhance Fundamental Traits’, Journal of Consumer Research(http://papers.ssrn.com/sol3/papers.cfm?abstract id=967676). For one attempt to leverage psycholo-gical findings to draw philosophical conclusions for the enhancement debate, see Bostrom, N. andOrd, T. 2006. ‘The Reversal Test: Eliminating Status Quo Bias in Bioethics’, Ethics, 116: 656–80(http://www.nickbostrom.com/ethics/statusquo.pdf ).

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than enhancing (‘‘Become More Than Who You Are’’) eliminated thepreference for non-fundamental over fundamental trait enhancements. Wecan rely on big pharmaceutical companies for our drugs, and on marketingfirms for our authenticity.

The chapter by A C considers some general argumentsagainst enhancement made by bioconservatives (‘‘anti-meliorists’’ inCaplan’s terminology), including concerns about authenticity and theworry that the happiness and satisfaction achieved though engineering isseductive and will lead to a deformation of our character and spirit. Caplanargues that neither of these arguments provides a sufficient reason foropposing enhancement or optimization either of ourselves or our children.He concludes that what we must do is ‘‘take each proposed enhancementtechnology under consideration and decide whether what it can do isworth whatever price it might exact’’.

Minor enhancements, such as a nootropic giving us a temporary 10or 20 per cent boost in our ability to memorize facts when studyingfor a medical exam, is one thing; but what about more radical forms ofenhancement? What of enhancements that would give us some significantnon-human characteristics? Or ones that could make us ‘‘post-human’’?These questions are addressed in a chapter by J S. Inparticular, Savulescu discusses the views put forward in ‘‘The humanprejudice’’, a posthumously published paper by the late philosopherBernard Williams. Williams argued that a prejudice in favor of ourhuman conspecifics is morally acceptable, by contrast to certain otherprejudices such as racism and sexism. Savulescu argues that Williams’defense of speciesism fails. Savulescu also shows how the issues raised inthis debate connect to fundamental problems in normative ethics and inmetaethics—such as internalism vs. externalism about normative reasons;the criteria for moral status; submaximization vs. satisficing; and the roleof partiality and special relations in determining our moral duties.

Enhancements of certain kinds

Even if there is no moral reason to forgo enhancement in general, theremight still be aspects of some particular types of enhancement that aremorally problematic.

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One morally charged context of enhancement is reproduction. Thereare many methods, low- and high-tech, by which we influence thecharacter of new persons being brought into the world. At one end ofthe spectrum, mate choice has an obvious effect on what our childrenwill be like, and the quality of prospective offspring is one factor thatcan influence our choice of romantic partners. According to evolutionarypsychology, sexual attraction is often keyed to a subconscious assessmentof the genetic quality of a potential mate (along with other factors). Thesefactors can also be taken into account when we consciously deliberate toselect among romantic prospects. We can also achieve ‘‘eugenic’’ objectivesby exerting choice over the timing of conception—for example, by takinginto account the increasing risk of birth defects associated with conceiving atan older age. Further, maternal nutrition and drug use can affect the fetus,and abortion can be used to terminate pregnancies when chromosomalabnormalities or other serious defects are detected. For couples undergoingin vitro fertilization, preimplantation genetic diagnoses can be used to selectembryos without the need for abortion. The number of genetic conditionsthat can be assayed will increase with advancing technology; it will likelybecome possible to select not only against genetic defects but also forgene combinations correlating with positive desirable traits. It is also likelythat more active forms of genetic interventions will become feasible, suchas gene therapy either on zygotes, gametes, or even on the reproductivesystems of adults, which could increase the likelihood that resulting embryoswill have genetic endowments correlating with desirable attributes. Afterbirth, parents and society continue to shape the character and capacities ofchildren through means including education, nutrition, and rearing.⁵

The context of reproduction involves making choices that directly andintimately affect not only the decision-maker but also the resulting children.This introduces distinctive moral elements that are not usually present tothe same extent in cases where a competent adult makes a free andinformed decision to enhance herself. Another complicating moral elementin reproduction is that our choices may determine which of several possiblepersons come into existence. According to many ethical theories, there arefundamental moral differences between cases in which our actions affect

⁵ Savulescu, J. 2006. ‘Genetic Interventions and the Ethics of Enhancement of Human Beings’. InThe Oxford Handbook on Bioethics, ed. B. Steinbock (Oxford: Oxford University Press), 516–35.

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some person who already exists or will come to exist independently ofour actions, and cases in which our actions result in the creation of a newperson who would not otherwise have existed.

Negative selection—selection against disability—has come under criti-cism, especially from some members of the disability community. Positiveselection—selection for some desired trait in our offspring other thanabsence of disability or disease—has generated even broader unease inthe public at large. D B examines a series of arguments for theclaim that selection of children is morally wrong, including expressivistconcerns, the ‘‘playing God’’ objection, the worry that selection mightundermine our unconditional acceptance of children, the critique of thenotion of ‘‘perfection’’, and the allegation that selection is in a bad senseeugenics. Brock argues that selection of our children is not in itself morallyproblematic, and concludes that ‘‘If negative or positive selection should berejected, it will have to be for other reasons, not simply because selectionof our children is wrong.’’

Some other moral considerations relating to genetic selection and geneticengineering of offspring are evaluated in the chapter by P S. Theobjection that genetic selection would be bad for the child does not work,Singer argues. Of greater concern are some of the potential societal effectsthat such enhancement could have. If Robert Nozick’s proposal to establisha ‘‘genetic supermarket’’ (i.e. letting prospective parents make their ownreproductive choices, within wide moral limits) were adopted, it couldlead to resources being squandered in a competitive pursuit of positionalgoods.⁶ Positional goods, such as height, are ones whose goodness forthose who have them depends on other subjects not possessing them. Anenhancement that had no effect other than making the user six inchestaller would provide no net benefit if universally applied. It might, onthe contrary, result in net losses inasmuch as food consumption wouldincrease, vehicles would need to be redesigned, etc. But as Singer notes,many enhancements would provide benefits that are not merely positional.A related concern is that genetic selection might aggravate inequality. Inprinciple there are many ways in which this concern could be assuaged: thetechnology could be made available to all, or only to the worst off; or othercompensating social policies could be put in place. (In practice, whether

⁶ Nozick, R. 1974. Anarchy, State and Utopia (New York: Basic Books), 315 n.

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any such measures were implemented would depend on the outcome ofpolitical struggles.) Singer points out that bans on genetic enhancementwould have limited effect if couples wishing to avail themselves of suchopportunities could simply travel to another state or another country inorder to do so. Moreover, nations that prohibit their citizens from usinggenetic enhancement might lose out in terms of economic competitivenessand fall behind countries that embrace enhancement.

S S discusses attitudes to prenatal selection in Japan,where screening is less accepted and less widely practiced than it isin many Western countries such as France, the United States, and theUnited Kingdom. In the mid-nineties, approximately 90 per cent of fetuseswith Down’s syndrome were aborted in these countries, while less than10 per cent of affected Japanese fetuses were aborted.⁷ This is not becauseJapanese culture is especially averse to abortion: some 350,000 abortions areperformed there annually. So what is the explanation? Shimazono suggestsseveral factors. In Japan, acceptance of abortion was historically driven notso much by women’s rights as by a concern to control population growthfor Malthusian reasons. To the extent that screening and selective abortionis a manifestation of women’s rights and reproductive freedom, the practicemight therefore have less historical backing than in the West. Shimazonoalso notes that while Westerners place great confidence in ‘‘reasoningpower that has become independent from nature and body’’ and stressself-determination of sovereign selves as indispensable for the value offreedom, Japanese culture places less weight on individual autonomy and ismore critical of the arrogance typically associated with modernization andmodern scientific technology. ‘‘Differences in the perceptions of prenatalgenetic diagnosis among different nations’’, Shimazono concludes, ‘‘suggestthat the culture and historical background of each nation affect people’sbioethics.’’

It would be a mistake to suppose that there exists a unified Asian outlookor Eastern set of values that is opposed to genetic selection. Consider, forexample, the situation in Singapore, whose former Prime Minister LeeKuan Yew spoke frequently about the heritability of intelligence and its

⁷ The exact figures vary between studies; for a review see Caroline Mansfield, Suellen Hopfer,Theresa M. Marteau, ‘‘Termination rates after prenatal diagnosis of Down syndrome, spina bifida,anencephaly, and Turner and Klinefelter syndromes: a systematic literature review’’, Prenatal Diagnosis,19(9): 808–12.

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importance for the country’s future, and whose government introducedmeasures explicitly designed to encourage university graduates to havemore children.⁸ And of course, attitudes can vary sharply even within acountry, as anyone familiar with public bioethics in the United States iswell aware.

One context in which enhancement is already in use and with provenefficacy is sports. This makes it an interesting case study. One should,however, be careful not unduly to generalize conclusions based on themodel of athletic performance enhancement, because competitive sportis characterized by certain features that are not present in many otherenhancement contexts. The advantage that an athlete gets from doping isa purely positional: he might win the race, but this benefit comes at theexpense of all the other athletes who rank lower as a result. Moreover,a sport (or a game more generally) is a peculiar kind of activity that isessentially constituted by more or less arbitrary conventions.⁹ In golf, thegoal is not simply to get the ball down in the hole— that could be achievedeasily by picking up the ball and placing it in the hole by hand—rather, thegoal is to sink the ball while following a set of rules whose justification maybe a combination of tradition, entertainment value, and fairness; but not(narrowly construed) instrumental utility. These and other factors combineto make sports ethics a distinct subfield of practical ethics.

T T draws a tristinction between ‘‘negative’’ interven-tions, aimed at curing a disease or eliminating a disability; ‘‘positive’’interventions, aimed at improving the functioning of a human organismwithin the range of natural variation; and ‘‘enhancement’’, by which hemeans an intervention aiming to take an individual beyond normal func-tioning of a human organism. In medicine in general, he says, we canaccept both positive measures and enhancement. In sports medicine, how-ever, both positive measures and enhancement are viewed with suspicion.Tännsjö believes that the rationale behind this suspicion

has to do with a very special aspect of the ethos of elite sport, the idea that inelite sport we search for the limits of what a human being can do, together with

⁸ Chan, C. K. and Chee, H. L. 1984. ‘Singapore 1984: Breeding for Big Brother’. In DesignerGenes: I.Q., Ideology and Biology, Institute for Social Analysis (Insan). Chan, C. K. and Chee, H. L. (eds.),(Malaysia: Selangor), 4–13. (Reference from Singer, this volume.)

⁹ Cf. Suits, B. 2005: The Grasshopper: Games, Life and Utopia (Ontario: Broadview Press).

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a very special notion of justice according to which we are allowed to admire theindividual who has drawn a winning ticket in the natural genetic lottery and excels.

Tännsjö himself, however, does not accept this special notion of justice, sohe is unwilling to embrace the ethos of elite sport. Without this ethos, hethinks, there is no need for a special medical ethics for sports medicine. It isenough if elite sport ‘‘provides us with good entertainment: fierce, fair, andunpredictable competition—a sweet tension of uncertainty of outcome.’’However, he suggests that if we do want to add something to this, it couldbe the following:

In elite sport we can test out the results of such enhancements and see, not wherethe limits are of the (given) human nature, but how far we can push them. Wecan enjoy what we see at the competition, and we can feel admiration for all thescientific achievements that have rendered possible the performances. And we canthank the athletes for taking the inconvenience to test them out before us.

C O, focusing particularly on life extension, argues thatsocial category identities are relevant for the ethics of enhancement. One’smembership in social categories such as sex, race, and socioeconomic class,she says, largely determines whether or not one has access to the benefitsof life enhancement and whether or not one can pay the costs of theseenhancements, making questions of access and exclusion important. Itwould also be a mistake to ignore the ways in which various enhancementpractices could affect social attitudes towards various groups. Overall makesthe point that enhancement could be used in equality-promoting ways bygiving opportunities to disadvantaged groups that they could not otherwisehave had. She criticizes bioconservative bioethicist Daniel Callahan’s viewthat older patients should be denied life-saving treatments on grounds thatthe normal human life cycle is already enough for a full life. Overall pointsout that the fullness of a life is not a simple function of age; since, forexample, people living in disadvantaged circumstances might have beendeprived of important experiences even if they have lived for a long time.Life extension could be the only way in which an old person who has liveda deprived life could get a fair shot at having a full life. One might alsoadd that even for somebody who is living a rich and flourishing life, theremay not be any point at which the life becomes ‘‘full’’ in the sense thatit could not possibly become better still if it were continued; and even ifthere were such a point there is no guarantee that it would coincide with

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one’s seventieth birthday or whatever the ‘‘natural lifespan’’ is taken to be.(Even a tree-life takes much more than three score and ten to complete, sowhy not a human life?¹⁰)

Francis Fukuyama, who in a widely-cited article nominated transhuman-ism as ‘‘the world’s most dangerous idea’’, believes that liberal democracydepends on the fact that all human beings share the same essence, whichin Fukuyama’s view consists in some undefined ‘‘factor X’’.¹¹ Were weto engage in enhancement we might unwittingly alter this factor X andthereby destroy the basis of human dignity and the idea of equality under-pinning the liberal democratic ideal. In this volume, D W,building on his own earlier work, considers specifically the prospect ofcognitive enhancement and asks whether civil liberties presuppose roughlyequal mental abilities.

Wikler begins by noting that egalitarians need not, and do not, assumethat everybody has the same cognitive capacities, or even the same geneticpredisposition to intelligence. One must distinguish the empirical claimof human equality of capacities (which is false) from the normative claimthat all competent human persons should have the same civic status (whichmight well be true). Wikler then draws our attention to the paternalismwith which we treat human beings with severe or moderate cognitiveimpairments. Mentally incompetent adults may be barred from voting andfrom making certain financial decisions, and may even be denied freedomof movement. Now, suppose that cognitive enhancement produced asizeable population of human beings as intellectually superior to what isnow a normally-intelligent person as the latter is to someone who is nowregarded as mentally incompetent. In this situation, could we remaining‘‘normals’’ be rightfully subjected to similar kinds of paternalistic restrictionthat in the present world are uncontroversially imposed on humans who arementally incompetent? After distinguishing between a relativistic view and

¹⁰ For arguments for the radical extension of the human lifespan, see Bostrom, N. 2008. ‘Letterfrom Utopia’, Studies in Ethics, Law, and Technology, 1 (http://www.nickbostrom.com/utopia.pdf ),and Bostrom, N. 2005: ‘The Fable of the Dragon-Tyrant’, Journal of Medical Ethics, 31: 273–7(http://www.nickbostrom.com/fable/dragon.pdf ).

¹¹ Fukuyama, F. 2002. Our Posthuman Future (New York: Farrar, Straus and Giroux), 149. For acritique of Fukuyama’s view, see Bostrom, N. 2004: ‘Transhumanism: The World’s Most DangerousIdea?’, Foreign Policy, September/October (http://www.nickbostrom.com/papers/dangerous.html),Bostrom, N. 2005: ‘In Defence of Posthuman Dignity’, Bioethics, 19: 202–14 (http://www.nickbostrom.com/ethics/dignity.pdf ), and Bailey, R. 2005: Libertarian Biology (New York: PrometheusBooks).

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a threshold view of what qualifies an individual for full civic status, Wikleranswers his own question with a tentative yes: under certain circumstancesat least, a future population of cognitively superior agents might have aduty to treat remaining normals paternalistically.

R H addresses one particular intellectual attribute: truth-orientation. He reviews three types of enhancement that might strengthenour truth-orientation: more recording and standardized statistics on ourlives, prediction markets on major disputed topics, and techniques or modi-fications that could render our minds more transparent. Trends towardsthese kinds of enhancement, he suggests, could reduce the epistemic viceof self-deception and bias—a vice that can be especially dangerous in amodern world with nuclear weapons and other powerful technologies.Yet, as Hanson notes, self-deception and bias are quite central features ofour present psyches, their prevalence having been demonstrated in manystudies as well as, according to Hanson, by the ubiquity of persistentdisagreements even among agents who have mutual knowledge of eachother’s opinion. We might balk at the prospect of living without illusionswhen we realize how jarringly different such lives would be from ouraccustomed condition. If so, we might also be tempted to seek to regulatethe behavior of others, including our distant descendants, for example bytrying to prevent the development of the technologies that would make anillusion-deprived condition feasible.

Hanson warns against the danger of moral arrogance. Aside from themoral importance of autonomy, he adduces also an epistemic reason forwhy we should be wary of imposing our moral views on others. Just as wecan be, and frequently are, overconfident in our beliefs regarding empiricalquestions, we can also be, and no doubt frequently are, overconfident inour moral beliefs. We often deceive ourselves into thinking that our moralconvictions are better supported by reason than they really are, and bettersupported than the moral convictions of those who disagree with us. Thiswarning applies particularly when we are tempted to regulate the behaviorof future generations of people:

We should also be especially wary of moral arrogance regarding the moral behaviorof our distant descendants, as those descendants will have a clear information advant-age over us; we cannot listen to them as we could when arguing with a contempor-ary. Our descendants will know of our advice, and also of many other things we donot know. In addition . . . they may well have a stronger truth orientation than us.

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The argument from moral arrogance, Hanson suggests, might cut especiallyagainst those who think we should limit truth-orientation enhancements:

The warning to beware of our self-deception regarding our moral abilities wouldseem to apply with a special force to those who argue the virtues of self-deception.After all, does not the pro-self-deception side in a debate seem more likely to beself-deceived in this matter?

Enhancement as practical challenge

Several of the authors represented in this book, including Francis Kammand Norman Daniels, express concerns about the difficulty of succeedingand ensuring sufficient safety when attempting to enhance complex systems.In the final chapter of the book, N B and A S

tackle this practical challenge of enhancement heads on.Bostrom and Sandberg observe that there is a widespread popular belief

in the ‘‘wisdom of nature’’, which we ignore at our peril. Many peopleprefer ‘‘natural’’ remedies and ‘‘natural’’ food supplements, and willinglyembrace ‘‘natural’’ ways of improving human capacities such as training,diet, and grooming. Interventions seen as ‘‘unnatural’’ or ‘‘artificial’’, bycontrast, are commonly viewed with suspicion—at least until they becomefamiliar enough to become assimilated into the category of the natural. Thisattitude seems to be especially pronounced in relation to unnatural ways ofenhancing human capacities, which are viewed as unwise, short-sighted,and hubristic. The belief in the wisdom of nature, Bostrom and Sandbergsuggest, can also manifest as diffusely moral objections against enhancement.

Bostrom and Sandberg then propose that the belief in the wisdom ofnature is partially true. A human being is a marvel of evolved complexity,and when we manipulate complex evolved systems which are poorlyunderstood, our interventions often fail or backfire. Bostrom and Sandbergseek to encapsulate the grain of truth contained in the belief in the wisdom ofnature in form of the Evolutionary Optimality Challenge. When somebodyproposes an intervention alleged to enhance some biological function ofcapacity, we should pose ourselves the following challenge: ‘‘Why, if thisintervention is such a good thing, have we not already evolved to be thatway?’’. Developing this evolutionary heuristic, Bostrom and Sandberg goon to explain and exemplify three categories of potential answers to the

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challenge question: changed tradeoffs, value discordance, and evolutionaryrestrictions. For some proposed enhancement interventions, a satisfactoryanswer to the evolutionary optimality challenge can be found in one ofthese categories, giving us a green light to proceed: we can see preciselywhy in the particular case at hand we can reasonably hope to improve onnature. For other proposed interventions, the heuristic gives a red light,suggesting that the intervention may not work, or may have long-termand perhaps subtle side-effects. In such cases, we may need to rethink ourenhancement idea or at least proceed with extreme caution.

The heuristic that Bostrom and Sandberg develop (inspired by the fieldof evolutionary medicine) is primarily empirical and practical in nature:it is intended to help researchers and enhancement users identify andevaluate promising enhancement interventions by providing a method forthinking through what evolutionary considerations can tell us about theirlikely effects on our minds and bodies. As such, the heuristic has no moralcontent. Yet if Bostrom and Sandberg are correct in surmising that anti-enhancement intuitions which surface as moral sentiments are sometimesrooted in an implicit belief in nature’s wisdom, then the heuristic canalso contribute to ethical discourse by allowing for a more transparent andconstructive way of acknowledging and taking into account these hiddenand subtle prudential concerns.

Conclusion

Human enhancement has moved from the realm of science fiction tothat of practical ethics. There are now effective physical, cognitive, mood,cosmetic, and sexual enhancers—drugs and interventions that can enhanceat least some aspects of some capacities in at least some individuals someof the time. The rapid advances currently taking place in the biomedicalsciences and related technological areas make it clear that a lot more willbecome possible over the coming years and decades. The question hasshifted from ‘‘Is this science fiction?’’ to ‘‘Should we do it?’’.¹²

¹² It remains important, however, to distinguish between what is possible today, what may becomefeasible soon, and what would require radical new technological capabilities to achieve. And inanswering the question of what is possible today, it is also important to distinguish proof-of-concept ina laboratory study from applications that are ready to be rolled out for widespread use.

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This book presents a wide variety of perspectives relevant to answeringthis question. Christine Overall, in an assessment which seems to besupported by many of our authors, opines that given the enormous variation,moral generalizations about all enhancement processes and technologies areunwise, and they should instead be evaluated individually. Whether weshould employ a particular enhancement depends on the reasons for andagainst that particular enhancement. Creating superimmunity to all knownbiological and viral insults is very different from practicing sports doping;choosing the personality traits of our offspring through genetic selectionis very different from taking a pill that temporarily boosts our abilityto concentrate. On this line of reasoning, it is time to take a furtherstep, from asking ‘‘Should we do it?’’ to analyzing the ‘‘it’’ and askinga number of much more specific questions about concrete actions andpolicy options related to particular enhancement issues within a givensociopolitical-cultural context. The result of this will not be a yes or noto enhancement in general, but a more contextualized and particularizedset of ideas and recommendations for how individuals, organizations, andstates should move forward in an enhancement era.¹³

Where do we go from here? We believe that the enhancement debateneeds to be developed simultaneously in two directions: both, as we mightsay, downwards and upwards. The ‘‘downwards’’ direction is the one justsuggested: zooming in on issues of more limited scale by disaggregatingand contextualizing enhancements, and addressing the particularities of thechoices faced by various stakeholders and decision-makers. The ‘‘upwards’’direction is to address ethical and pragmatic challenges that emerge whenwe zoom out and consider the roles that enhancement of various types ofcapacity could play in the long term and big-picture future of humanity.This would require discussing how enhancement—including the pro-spect of future more radical enhancement—might interact with othermacro-trends and global problems and prospects such as economic growthand inequality, existential risks and global catastrophic risks, molecularnanotechnology, artificial intelligence, space colonization, virtual reality,surveillance technology, democracy and global governance, along withthe deep epistemological, methodological, and moral questions that arise

¹³ Savulescu, J. 2003. ‘Human–animal transgenesis and chimeras might be an expression of ourhumanity’, Am J Bioethics. Summer, 3(3): 22–5.

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when one attempts to think about these interlocking issues in a seriousand critical manner.¹⁴ These two directions may seem to be in tension toone another, but in fact they simply point to two coexisting intellectualfrontiers, each with important and worthy problems to be addressed. Adanger we see for enhancement ethics is its getting stuck in the middle.An uncritical acceptance of ‘‘enhancement’’ as an analytical category andas a organizing idea for our inquiries risks obscuring the heterogeneity ofpotential enhancement applications and the need to situate them within themicro-context of particular policy decisions, as well as within the macro-context constituted by other big-picture challenges for humanity in thetwenty-first century. In some circumstances, regulated access may be fairerand safer than prohibition.¹⁵ In other cases, enhancements could be selectedto address inequality or social injustice,¹⁶ or deployed at a population levelfor societal benefit. One spokesperson for the US Military, which is activelyexploring the potential of human enhancement technology, said

The world contains approximately 4.2 billion people over the age of twenty. Evena small enhancement of cognitive capacity in these individuals would probablyhave an impact on the world economy rivaling that of the internet.¹⁷

It seems likely that this century will herald unprecedented advances innanotechnology, biotechnology, information technology, cognitive sci-ence, and other related areas. These advances will provide the opportunity

¹⁴ See e.g. Bostrom, N. 2007. ‘Technological Revolutions and the Problem of Prediction’. In Nano-ethics: The Ethical and Social Implications of Nanotechnology. Allhoff, F., Lin, P., Moor, J. and Weckert, J.(eds.), Wiley-Interscience (http://www.nickbostrom.com/revolutions.pdf ), and Bostrom, N. 2007.‘The Future of Humanity’. In New Waves in Philosophy of Technology. Berg Olsen, J. K., Selinger, E.and Aldershot, S. R. (eds.) (Basingstoke: Palgrave Macmillan).

¹⁵ Savulescu, J., ‘It Is Time to Allow Doping at the Tour de France’,The Telegraph, 30 Jul. 2007.http://www.telegraph.co.uk/sport/main.jhtml?view=DETAILS&grid=A1YourView&xml=/sport/2007/07/30/sodrug130.xml, accessed 8 February 2008. ‘Doping true to the Spirit of Sport’, JulianSavulescu, Sydney Morning Herald, Aug. 8, http://www.smh.com.au/news/opinion/doping-true-to-the-spirit-of-sport/2007/08/07/1186252704241.html, accessed 8 Feb. 2008. J Savulescu, B Foddy,and M Clayton, ‘Why we should allow performance enhancing drugs in sport’, in British Journal ofSports Medicine, Dec. 2004; 38: 666–70. Savulescu, J., and Foddy, B., 2007. ‘Ethics of PerformanceEnhancement in Sport: Drugs and Gene Doping’, in Principles of Health Care Ethics, Second Edition,Ashcroft, R E., Dawson, A., Draper, H. and McMillan, J. R (eds.) (London: John Wiley & Sons, Ltd),511–20.

¹⁶ Savulescu, J. 2006. ‘Justice, Fairness and Enhancement’. In Progress in Convergence: Technologies forHuman Wellbeing, eds. Sims Bainbridge, W. and Roco, M. C. Annals of the New York Academy of Sciencesvol. 1093 doi: 10.1196/annals.1382.021, Ann. N.Y. Acad. Sci. 1093: 321–38.

¹⁷ Army: Proposal Submission, at http://www.dodsbir.net/solicitation/sttr08A/army08A.htm, acc-essed 8 Feb. 2008.

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fundamentally to change the human condition. This presents both greatrisks and enormous potential benefits. Our fate is, to a greater degree thanever before in human history, in our own hands.

To decide whether we have reason to promote a particular enhancementwill require wisdom, dialogue, good scientific research, good public policy,and academic debate. This book represents one of the first steps to advancingacademic discussion of enhancement from a variety of analytic philosophicalperspectives. It is neither our expectation nor our primary objective thatreaders will be persuaded either to support or oppose enhancement. Rather,our hope is that the book will cause its readers to reflect more deeply onone of the most important and challenging issues of the new century.¹⁸

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¹⁸ We are grateful to Rebecca Roache for valuable comments on an earlier version of thisintroduction.

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